Rj. Cooper et al., Principles of appropriate antibiotic use for acute pharynigitis: Background (reprinted from Annals of Internal Med, March 20, 2001), ANN EMERG M, 37(6), 2001, pp. 711-719
The following principles of appropriate antibiotic use for adults with acut
e pharyngitis apply to immunocompetent adults without complicated comorbid
conditions, such as chronic lung or heart disease, and history of rheumatic
fever. They do not apply during known outbreaks of group A streptococcus.
1. Group A P-hemolytic streptococcus (GABHS) is the causal agent in approxi
mately 10% of adult cases of pharyngitis. The large majority of adults with
acute pharyngitis have a self-limited illness, for which supportive care o
nly is needed.
2. Antibiotic treatment of adult pharyngitis benefits only those patients w
ith GABHS infection. All patients with pharyngitis should be offered approp
riate doses of analgesics and antipyretics, as well as other supportive car
e.
3. Limit antibiotic prescriptions to patients who are most likely to;have G
ABHS infection. Clinically screen all adult patients with pharyngitis far t
he presence of the four Center criteria: history of fever, tonsillar exudat
es, no cough, and tender anterior cervical lymphadenopathy (lymphadenitis).
Do not test or treat patients with none or only one of these criteria, sin
ce these patients are unlikely to have GABHS infection. For patients with t
wo or more criteria the following strategies are appropriate: (a) Test pati
ents with two, three, or four criteria by using a rapid antigen test, and l
imit antibiotic therapy to patients with positive test results; (b) test pa
tients with two or three criteria by using a rapid antigen test, and limit
antibiotic therapy to patients with positive test results or patients with
four criteria; or (c) do not use any diagnostic tests, and limit antibiotic
therapy to patients with three or four criteria.
4. Throat cultures are not recommended for the routine primary evaluation o
f adults with pharyngitis or for confirmation of negative results on rapid
antigen tests when the test sensitivity exceeds 80%. Throat cultures may be
indicated as part of investigations of outbreaks of GABHS disease, for mon
itoring the development and spread of antibiotic resistance, or when such p
athogens as gonococcus are being considered.
5. The preferred antibiotic for treatment of acute GABHS pharyngitis is pen
icillin, or erythromycin in a penicillin-allergic patient.